A More Aggressive Approach to Emergency Embolectoniy for Acute Pulmonary Embolism

Sareyyupoglu, Basar; Greason, Kevin L.; Suri, Rakesh M.; Keegan, Mark T.; Dearani, Joseph A.; Sundt III, Thoralf M.
September 2010
Mayo Clinic Proceedings;Sep2010, Vol. 85 Issue 9, p785
Academic Journal
OBJECTIVE: To examine operative outcomes after acute pulmonary embolectomy (APE), a recently adopted, more aggressive surgical approach. PATIENTS AND METHODS: We retrospectively identified patients who underwent surgical APE from April 1, 2001, through March 31, 2009, and reviewed their clinical records for perioperative outcome. Operations were performed with normothermic cardio- pulmonary bypass and a beating heart, absent a patent foramen ovaie. For completeness, embolectomy was performed via separate incisions in the left and right pulmonary arteries (PAs) In 15 patients. RESULTS: Of the 18 patients identified, the mean age was 60 years, and 13 patients (72%) were men. Thirteen patients (72%) had been hospitalized recently or had systemic disease. The preoperative diagnosis was established by echocardiography or computed tomography (or both). The median (range) follow-up time for all surviving patients was 16 months (2-74 months). Indications for APE included cardiogenic shock (n=12; 67%) and severe right ventricular dysfunction as shown by echocardiography (n=5; 28%). Seven patients (39%) had an embolus in transit. Seven patients (39%) experienced cardiopulmonary arrest before APE. Four early deaths (22%) occurred; all 4 of these patients had preoperative cardiopulmonary arrest, and 2 had APE via the main PA Only, without branch PA incisions. Two late deaths (11%) occurred. Right ventricular function improved in all survivors. CONCLUSION: The results of emergent APE are encouraging, particularly among patients without cardiopulmonary arrest. It should not be reserved for patients in extremis; rather, it should be considered for patients with right ventricular dysfunction that is an early sign of impending hemodynamic collapse.


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